Your Member Handbook
Please read your Member Handbook. It tells you:
- About your health plan.
- About your benefits and what is covered.
- How to get the services you need, including special health care needs.
- How to contact us.
- Your rights and responsibilities as a member.
Alternate MCO DCFS Training (Non-YouthCare plans) - Attachment 1: DCFS Member Handbook Language
Certificate of Coverage and Document of Coverage
Molina Healthcare Members receive a Molina Healthcare Certificate of Coverage and Document of Coverage in their new member welcome packet.
Waiver Programs
The Illinois Department of Human Services has a variety of waiver programs available for people who qualify. Members who qualify will receive information on program benefits in their new Member welcome packet. The Waiver Program Handbook Supplement tells you:
- About eligibility requirements to qualify for waiver programs.
- About the five waiver programs.
- The home and community-based services available under each waiver program.
Need your Member Handbook in a different language or format?
Call Member Services at (855) 687-7861.
If you need a printed copy of any of these materials mailed to you, call Member Services at (855) 687-7861.
انقر هنا لقراءة محتوى هذ الموقع الإلكتروني باللغة العربية.
点击这里浏览中文（繁体）版本的网站内容
CMS-0057 Prior Authorization Annual Reporting
This report shows how prior authorization requests are handled, such as how many were approved or denied and how quickly decisions were made. To find out if a specific service needs prior authorization, members and providers should check the plan’s Prior Authorization Guide or use the Prior Authorization Lookup Tool.
Prior Authorization Guide 2025
Prior Authorization Lookup Tool
Illinois Medicaid Prior Authorization Annual Report 2025
|
Prior Authorization Statistics
|
Molina Healthcare Inc
Percentage
|
|
The percentage of
STANDARD
prior authorization requests that were approved,
aggregated for all items and services.
|
86%
|
|
The percentage of
STANDARD
prior authorization requests that were denied,
aggregated for all items and services.
|
14%
|
|
The percentage of
STANDARD
prior authorization requests that were approved
after an appeal, aggregated for all items and
services.
|
52%
|
|
The percentage of
EXPEDITED
prior authorization requests that were approved
after an appeal, aggregated for all items and
services.
|
69%
|
|
The percentage of
STANDARD
prior authorization requests for which the review
timeframe was extended, and the request was
approved, aggregated for all items and services.
|
64%
|
|
The percentage of
EXPEDITED
prior authorization requests for which the review
timeframe was extended, and the request was
approved, aggregated for all items and services.
|
74%
|
|
The percentage of
EXPEDITED
prior authorization requests that were approved,
aggregated for all items and services.
|
92%
|
|
The percentage of
EXPEDITED
prior authorization requests that were denied,
aggregated for all items and services.
|
8%
|
|
|
Timing
|
|
Average
time that elapsed between the submission of a
request and a determination by the payor, plan or
issuer, for
STANDARD
prior authorizations, aggregated for all items and
services. (Measured in days)
|
2
|
|
Median time that elapsed between
the submission of a request and a determination by
the payor, plan, issuer, for
STANDARD
prior authorizations, aggregated for all items and
services. (Measured in days)
|
1
|
|
Average
time that elapsed between the submission of a
request and a decision by the payor, plan or
issuer, for
EXPEDITED
prior authorizations, aggregated for all items and
services. (Measured in hours)
|
20
|
|
Median time that elapsed between
the submission of a request and a decision by the
payor, plan, issuer, for
EXPEDITED
prior authorizations, aggregated for all items and
services. (Measured in hours)
|
19
|
|
